Provider Demographics
NPI:1407676653
Name:BATILO, JUSTINEANN (AGNP-C)
Entity type:Individual
Prefix:
First Name:JUSTINEANN
Middle Name:
Last Name:BATILO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:BATILO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:4119 CORPORAL KENNEDY ST # 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2757
Mailing Address - Country:US
Mailing Address - Phone:646-436-0505
Mailing Address - Fax:
Practice Address - Street 1:4119 CORPORAL KENNEDY ST # 1
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2757
Practice Address - Country:US
Practice Address - Phone:646-436-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311988363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care